Key result
Medical therapy resolves dynamic post-TAVR LVOT obstruction, lowering gradients by ~74 mm Hg to reverse shock.
Why the study?
Dynamic left ventricular obstruction is an uncommon and potentially fatal cause of obstructive shock after transcatheter aortic valve replacement that requires early recognition and management.
Case Report (n=1)
Early identification by echocardiography and targeted medical therapy (preload/afterload augmentation and beta-blockade) can successfully resolve life-threatening dynamic left ventricular outflow tract obstruction (suicide left ventricle) post-TAVR.
Alerts clinicians to suicide LV risk after TAVR in hypertrophic patients; extends sparse case data but leaves prevention and management open.
BACKGROUND: Dynamic left ventricular obstruction, often referred to as suicide left ventricle, is an uncommon and potentially fatal cause of obstructive shock after transcatheter aortic valve replacement (TAVR). CASE SUMMARY: An 89-year-old man with severe symptomatic aortic stenosis, severe concentric hypertrophy, and a small left ventricular cavity underwent transfemoral TAVR. Fifteen minutes after deployment of a 29-mm self-expanding valve, he developed hemodynamic collapse. Multimodality assessment excluded major procedural complications. At 30 minutes, echocardiography confirmed dynamic left ventricular outflow tract obstruction, with a peak gradient of 86 mm Hg, systolic anterior motion, mild mitral regurgitation, and an associated midventricular gradient. Volume expansion, phenylephrine, and propranolol reduced the gradient to 12 mm Hg, with shock resolution within 24 hours. DISCUSSION: Early echocardiography identifies this obstructive physiology and redirects therapy toward preload and afterload augmentation, withdrawal of beta-adrenergic stimulation, and beta-blockade. TAKE-HOME MESSAGES: Dynamic left ventricular outflow tract obstruction should be suspected in early post-TAVR shock.
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Eslava-Galvez et al. (2026) conducted a case report in Obstructive shock after transcatheter aortic valve replacement (TAVR) (n=1). Volume expansion, phenylephrine, and propranolol was evaluated on Resolution of dynamic left ventricular outflow tract obstruction and shock. Volume expansion, phenylephrine, and propranolol successfully reduced the dynamic left ventricular outflow tract gradient from 86 to 12 mm Hg, resolving post-TAVR shock within 24 hours.
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